- Centene Corporation (Phoenix, AZ)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Molina Healthcare (Phoenix, AZ)
- …a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- CVS Health (Phoenix, AZ)
- …management function. **Required Qualifications** + 1+ year: Oncology and Transplant UM, concurrent review or prior authorization + 3+ years: acute ... 100% participation during 8:30am-5pm EST Monday-Friday As a UM Nurse Consultant you will work in a clinical... Nurse Consultant you will work in a clinical telephone queue working with providers to secure additional… more
- CVS Health (Phoenix, AZ)
- …+ 1+ year varied Utilization Management experience within an inpatient/Outpatient setting, concurrent review or prior authorization. + 5+ years of variety ... coverage (URAC and Client Requirements).** Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and… more
- HonorHealth (Scottsdale, AZ)
- …urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, ... Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- Dignity Health (Phoenix, AZ)
- …clinical social work and best practice in medical necessity determination and concurrent review . The Director will support the Organization's strategic plan ... the oversight of care coordination and social services, including but not limited to clinical resource management, discharge planning activities, patient advocacy, … more
- HonorHealth (Scottsdale, AZ)
- …transition to next level of case management or care coordination services. Performs concurrent review of patient treatment plans in accordance with the hospital ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more